Rural and Indigenous Healthcare

As a young health professional, I have practiced and worked in a diverse range of settings and have had the opportunity to experience a variety of roles prior to entering medical school. I’ve come to ponder upon the future of healthcare in Australia and the current trajectory and circumstances. Whilst, I acknowledge that my view is not conclusive and am not attempting reprimand or critique rather to highlight the issues that are explicitly evident in the healthcare system.

My first concern relates to the state of rural and indigenous healthcare. I have worked within the hospital setting both in Central Australia and rural South Australia. Indigenous health is a passion of mine and we are all well aware of the challenges faced by practitioners intent on closing the gap. Rural healthcare, of which indigenous health is an integral component is faced with enormous obstacles. There is an evident lack of resources and facilities that creates difficulties in delivering optimal care to patients.

Furthermore, it is a challenge to recruit and retain health professionals to stay long-term and to help address these health disparities, thereby creating long waiting periods that progress and complicate health status of patients. Moreover, the vastness of this magnificent continent generates logistical challenges in delivering care. Patients often travel long distances or may not have access to transport to seek help.

Of indigenous health so much requires attention. Most obviously the communication and cultural barriers that impede and disconnect the patients from their health professionals. In addition the social factors that create a revolving door approach to healthcare. Factors such as inadequate accommodation, nutrition, employment and education are essential to maintaining good health. What of the cultural unpreparedness of health professionals dealing with indigenous patients? How can we integrate contemporary medicine with indigenous health concepts and spirituality? Hope is not lost, mainstream Australia is awaken to the ever widening health disparities…

Another major issue is the ageing population of Australia. This dilemma is confronted by many other countries and is not unique to Australia. Advances in medicine have led to improvements in quality of life and increased life expectancy of patients. The ageing population will be placing enormous demands on resources, trained staff and healthcare accessibility. The issues are complicated by an ever-growing list of new and costly therapeutics that place further pressure on finite resources. Is the current healthcare system prepared for the future? Are patients and health professionals positioned to accept the limitations of the current model and finite resources?

Related to the previous paragraph is the growth of chronic and lifestyle diseases that are becoming more prevalent in younger adults and children. We are faced with a growing epidemic of obesity, diabetes and Cardiovascular disease. These iIllnesses were absent in or less prevalent in previous generations of similar age group. This places further pressure on resources and management of complications associated with these conditions. Nevertheless, hope is not lost and positive steps in the right direction are being taken….More on that in my next update.

Figuring figure1

Have you heard of figure1? The app on android and iOS that aims to share images of the diverse range of ailments that afflict humanity? Its been publicised as an Instagram like app for health professionals. It gives an opportunity for health professionals to share interesting cases with other like-minded people around the world. The app offers opportunity for spot diagnosis, discussion of unusual/difficult cases and sharing of ideas regarding treatments. Its particularly targeted to medical students who have not transitioned to the clinical years.

Nevertheless,  the app hasn’t been without controversy.  There is always concern about the potential for patient identities being revealed. We can also never be certain that patients have actually given consent to have their photos uploaded into the ether and for sharing with a large community. Moreover, for the general public who can also access the app it reveals the gruesome side of medicine. A side that is rarely evident behind the closed curtains of emergency departments, operating theatres and deep insight the labyrinths of hospital wards.  It reveals the coping strategies that some doctors utilise to deal with extremely confronting issues of life and death.

An example being a picture of a man with a nail through his hand and a comment post stating “nailed it” reveals that dark humour that can be pervasive within the medical profession.

I’m keen to hear what you guys think about figure1. Do you use it as a study tool to explore different cases? Have you ever felt confronted or had a negative experience? Be sure to leave a comment and share your thoughts.

Communicating or Not?

I’ve been pondering the approaches to good communication by health professionals. We know that good communication is fundamental to delivery of care to our patients. But what defines this:

  • Language style: I think it is imperative for our language style to be age appropriate and take into account our patients level of education, cultural background and understanding about their own health status. I’ve often had to significantly change my communication style, word usage and sentence structure to suite our indigenous patients that I worked with prior to entering medical.
  • Active listening: An important component of communication is active listening, which takes into account our own body language, assessing the contents of the patients conversation, their body language, belief system and culture. These are important for indigenous patients where cultural difference can lead to a break down in communication. I’m still working on this point.
  • Provision of information: This relates to the first point and it should be simple, clear and direct. We must avoid our moral values and beliefs from interfering with the extent and breadth of information provided to patients. More importantly we should allow the patient to draw their own conclusions based upon life circumstances.
  • Questions: Our patients should be given ample opportunity to ask questions, clarifications and validations of key facts presented. This ensures that both parties agree and understand the facts presented during the conversation
  • Summarise: Prior to ending the conversation we should summarise the information presented and allow opportunity for the patient to ask questions. Furthermore, we must make ourself available for further discussion if the need arises.

Also check out the seven daily sins of speaking


7 Qualities To A Good Health Professional

There are several quintessential characteristics that contribute to an outstanding health professional. Here are my thoughts on this subject matter.

  1. Compassion, kindness and empathy: These are fundamental qualities that should be pursuit by all health professionals. We are often interacting with patients in their most vulnerable state, therefore our interactions must encompass this. Our ability to empathise stems from our emotional intelligence, life experience and shared/common experience with our patients.
  2. Trust: Another important quality demonstrated by health professionals. We often have access to private or sensitive information about our patients. This is a privilege and vital for harmonious and fruitful relationship between health professionals and patients. All efforts should be made to maximise this relationship, therefore trust is the key.
  3. Communication: The importance of this quality cannot be overstated. Without effective communication skills information cannot be expressed adequately or accurately. Moreover our communication skills must be audience specific. Encompassed within communication is active listening.
  4. Ethical and moral conduct: Given the nature of our work and the importance of our relationship with patients and society at large we must behave ethically and uphold our professional codes of conduct. We must do no harm to our patients, respect their autonomy, privacy and consent.
  5. Leadership: We must demonstrate leadership within the context of our own profession and more broadly in the healthcare system. I’m a vehement believer of public advocacy to better health outcomes for patients and their communities.
  6. Knowledge and Intellect: In order to ensure appropriate decision-making and safe practice, health professionals must possess the intellectual rigour and training to provide outstanding care.
  7. Researchers and Teachers: Contemporary medicine relies on the utilisation of evidence-based practice and we must pay diligence to this corner stone of healthcare by actively engaging in quality research. Associated with this is to be comfortable with critical thinking and problem-solving skills.  Moreover, we must endeavour to train and guide younger health professionals in their development and intellectual growth.

Please feel free to contribute to qualities that I may have omitted. I’m keen to hear how you prioritise the qualities of health professionals.